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. 2018 Feb;23(1):23-31.
doi: 10.1177/1358863X17736152. Epub 2017 Oct 25.

Burden of hospitalization in clinically diagnosed peripheral artery disease: A community-based study

Adelaide M Arruda-Olson  1 , Homam Moussa Pacha  1 , Naveed Afzal  2 , Sara Abram  1 , Bradley R Lewis  1 , Iyad Isseh  1 , Raad Haddad  1 , Christopher G Scott  2 , Kent Bailey  2 , Hongfang Liu  2 , Thom W Rooke  1 , Iftikhar J Kullo  1
Affiliations

Burden of hospitalization in clinically diagnosed peripheral artery disease: A community-based study

Adelaide M Arruda-Olson et al. Vasc Med. 2018 Feb.

Abstract

The burden and predictors of hospitalization over time in community-based patients with peripheral artery disease (PAD) have not been established. This study evaluates the frequency, reasons and predictors of hospitalization over time in community-based patients with PAD. We assembled an inception cohort of 1798 PAD cases from Olmsted County, MN, USA (mean age 71.2 years, 44% female) from 1 January 1998 through 31 December 2011 who were followed until 2014. Two age- and sex-matched controls ( n = 3596) were identified for each case. ICD-9 codes were used to ascertain the primary reasons for hospitalization. Patients were censored at death or last follow-up. The most frequent reasons for hospitalization were non-cardiovascular: 68% of 8706 hospitalizations in cases and 78% of 8005 hospitalizations in controls. A total of 1533 (85%) cases and 2286 (64%) controls ( p < 0.001) were hospitalized at least once; 1262 (70%) cases and 1588 (44%) controls ( p < 0.001) ≥ two times. In adjusted models, age, prior hospitalization and comorbid conditions were independently associated with increased risk of recurrent hospitalizations in both groups. In cases, severe PAD (ankle-brachial index < 0.5) (HR: 1.25; 95% CI: 1.15, 1.36) and poorly compressible arteries (HR: 1.26; 95% CI: 1.16, 1.38) were each associated with increased risk for recurrent hospitalization. We demonstrate an increased rate of hospitalization in community-based patients with PAD and identify predictors of recurrent hospitalizations. These observations may inform strategies to reduce the burden of hospitalization of PAD patients.

Keywords: hospitalization; peripheral artery disease (PAD); vascular medicine.

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Conflict of interest statement

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Ascertainment of PAD cases in Olmsted County, Minnesota, USA. REP, Rochester Epidemiology Project; PAD, peripheral artery disease. aAfter chart abstraction: 200 were classified as definite PAD, 15 probable PAD, 8 possible PAD, 2 non-atherosclerotic PAD, 172 unknown, and 718 were definitely not PAD.
Figure 2
Figure 2
Incidence of first hospitalization by the number of guideline-recommended strategies.
See this image and copyright information in PMC

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